Provider Demographics
NPI:1679084701
Name:BAILEY, MABRY LYNNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MABRY
Middle Name:LYNNE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PENN ST
Mailing Address - Street 2:
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038-3933
Mailing Address - Country:US
Mailing Address - Phone:662-820-1289
Mailing Address - Fax:
Practice Address - Street 1:101 PENN ST
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-3933
Practice Address - Country:US
Practice Address - Phone:662-820-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist